Specialist palliative care use for older people receiving aged care

In the absence of data on patient preferences, place of death offers important insights into whether end-of-life care was delivered in hospital or in the community.

In this section, place of death is presented for 3 settings of care – people who, at the time of death, were in hospital (including emergency departments), residential aged care, or other settings (deaths that did not occur in hospitals or residential aged care; see Appendix B for further details).

1 in 3 deaths among older people occurred in residential aged care

Among the study population (people aged 65 and over), at the time of death:

• 40% were in hospital (including emergency departments)
• 36% were in residential aged care
• 25% were in other settings.

4 in 5 residential aged care users died in that setting

Place of death varied by care setting in the last year of life. People living in residential aged care in the last year of life were more likely to die in residential aged care (82%) than in hospital (17%) or other settings (1.0%). In contrast, people using home care and residential respite care in the last year of life were more likely to die in hospital (50%) than in residential aged care (14%) or other settings (36%). Among people not receiving any of the selected aged care services in the last year of life, 57% died in hospital and 43% died in other settings.

Specialist palliative care recipients more likely to die in hospital

Two thirds (67%) of people who received specialist palliative care in the last year of life died in hospital, compared with 23% of those who did not receive specialist palliative care. Residential aged care was the most common place of death for people who did not receive specialist palliative care (50%).

Cancer deaths more likely in hospital, dementia deaths more likely in residential aged care

People who died from cancer were more likely to die in hospital (46%) than in residential aged care (22%). In contrast, people who followed the frailty and dementia trajectory were more likely to die in residential aged care (69%) than in hospital (22%), and people who followed the organ failure trajectory were equally likely to die in both settings (39% in hospital and 39% in residential aged care).

1 in 2 older people admitted to hospital in the last 4 weeks of life

Transitions between settings in the last month of life provide important insights on the mix of hospital and residential aged care services used.

Among the 132,000 people in the study population, 48% were admitted to a public hospital in the last 4 weeks of life (Table 6). Of these:

• 75% died in hospital
• 14% returned to their usual place of residence
• 6.4% were transferred to a residential aged care 
• 4.7% were transferred to another setting (which may include private hospitals). 

Among those admitted to public hospital in the last 4 weeks of life, people living in residential aged care were less likely to die in hospital compared with people using home care and residential respite care and people not receiving any of the selected aged care services (51%, 77% and 85%, respectively).